Artemisia absinthium

Is it safe?

Adverse events

Wormwood oil has been reported to cause nausea, vomiting and muscle aches.1 There have been very few anecdotal reports of the toxicity of Artemisia.2 Chronic ingestion of absinthe, an alcoholic drink containing wormwood, has been reported to be linked to a syndrome known as absinthism. This is said to consist of gastro-intestinal symptoms, insomnia and hallucinations.1 More severe adverse effects such as addiction, paralysis, epilepsy, brain damage, and psychiatric disorders and suicide have also been reported. However, the possible contribution of chronic alcohol intake has been also highlighted and the existence of a separate syndrome questioned.14 There has also been a suggestion that some symptoms may be due to adulteration with metals or toxic plants.1 One case of rhabdomyolysis leading to acute renal failure has been reported following accidental ingestion of 10ml of wormwood oil purchased on the internet.15 Artemisia absinthia is a member of the Asteraceae/Compositae (daisy, sunflower etc.) family and may cause allergic reactions in people who are allergic to other plants in this group.4

Contraindications

Wormwood has been assessed as likely unsafe for use in pregnancy if amounts larger than those found in food stuffs are ingested.1 Insufficient information is available to assess its safety in lactation. Thujone containing extracts have potentially toxic effects and therefore pose a particular risk with equivocal evidence on carcinogenicity from animal studies.16

Wormwood is contraindicated in obstruction of the bile duct, cholangitis and liver disease.4

Interactions

Thujone is metabolised via the cytochrome P450 enzyme system with involvement of the specific enzymes CYP2A6, CYP3A4 and CYP2B6.16 Therefore, there is a theoretical risk of interactions with drugs and other herbs metabolised via this system. There is also a risk if used with other thujone-containing herbs such as Salvia spp. (sage) or Thuja spp.

Due to its potential effects on the central nervous system, there is a potential for interaction with anti-convulsant (anti-epilepsy) drugs 1 and with drugs that act via GABA receptors.4

One case has been reported of a probable interaction between warfarin and Artemisia absinthium leading to gastrointestinal bleeding.18

Warnings

These relate particularly to thujone-containing extracts. The European Medicines Agency recommends caution in people with gall-bladder disease or other biliary disorders and that driving and operating machinery is avoided during treatment.4 Most forms of tinctures contain alcohol.

Legal notice
The present documentation has been compiled by the CAM-CANCER Project with all due care and expert knowledge. However, the CAM-CANCER Project provides no assurance, guarantee or promise with regard to the correctness, accuracy, up-to-date status or completeness of the information it contains. This information is designed for health professionals. Readers are strongly advised to discuss the information with their physician. Accordingly, the CAM-CANCER Project shall not be liable for damage or loss caused because anyone relies on the information.